Microchimerism
Microchimerism is the presence of a small number of cells in an individual that have originated from another individual and are therefore genetically distinct. This phenomenon may be related to certain types of autoimmune diseases although the responsible mechanisms are unclear. The term comes from the prefix "micro" + "chimerism" based on the hybrid Chimera of Greek mythology. The concept was first discovered in the 1960s with the term gaining usage in the 1970s.
Types
Human
In humans, the most common form is fetomaternal microchimerism whereby cells from a fetus pass through the placenta and establish cell lineages within the mother. Fetal cells have been documented to persist and multiply in the mother for several decades. The exact phenotype of these cells is unknown, although several different cell types have been identified, such as various immune lineages, mesenchymal stem cells, and placental-derived cells. A 2012 study at the Fred Hutchinson Cancer Research Center, Seattle, has detected cells with the Y chromosome in multiple areas of the brains of deceased women.Fetomaternal microchimerism occurs during pregnancy and shortly after giving birth for most women. However, not all women who have had children contain fetal cells. Studies suggest that fetomaternal microchimerism could be influenced by killer-cell immunoglobulin-like ligands. Lymphocytes also influence the development of persisting fetomaternal microchimerism since natural killer cells compose about 70% of lymphocytes in the first trimester of pregnancy. KIR patterns on maternal natural killer cells of the mother and KIR ligands on the fetal cells could have an effect on fetomaternal microchimerism. In one study, mothers with KIR2DS1 exhibited higher levels of fetomaternal microchimerism compared to mothers who were negative for this activating KIR.
The potential health consequences of these cells are unknown. One hypothesis is that these fetal cells might trigger a graft-versus-host reaction leading to autoimmune disease. This offers a potential explanation for why many autoimmune diseases are more prevalent in middle-aged women. Another hypothesis is that fetal cells come to injured or diseased maternal tissue where they act as stem cells and participate in repair. It is also possible that the fetal cells are merely innocent bystanders and have no effect on maternal health.
After giving birth, about 50–75% of women carry fetal immune cell lines. Maternal immune cells are also found in the offspring yielding in maternal→fetal microchimerism, though this phenomenon is about half as frequent as the former.
Microchimerism had also been shown to exist after blood transfusions to a severely immunocompromised population of patients who suffered trauma.
Other possible sources of microchimerism include gestation, an individual's older sibling, twin sibling, or vanishing twin, with the cells being received in utero. Fetal-maternal microchimerism is especially prevalent after abortion or miscarriage.
Animal
Microchimerism occurs in most pairs of twins in cattle. In cattle, the placentas of fraternal twins usually fuse and the twins share blood circulation, resulting in exchange of cell lines. If the twins are a male–female pair, then XX/XY microchimerism results, and male hormones partially masculinize the heifer, creating a martin heifer or freemartin. Freemartins appear female, but are infertile and so cannot be used for breeding or dairy production. Microchimerism provides a method of diagnosing the condition, because male genetic material can be detected in a blood sample.Fetomaternal microchimerism in the brain
Several studies have identified male DNA in the brains of both humans and mice who have previously been pregnant with a male fetus. It has been suggested that the fetal-derived cells can differentiate into those capable of presenting immunomarkers on their surface. There has been no strong evidence to say microchimerism of the maternal brain leads to disease; however, Parkinson's disease correlates with a higher incidence of brain microchimeras. Alzheimer's disease studies support nearly the opposite correlation: the more fetal-derived cells present, the lower the chance of the patient having had Alzheimer's.Maternal tolerance to paternal-fetal antigens
There are many mechanisms at the maternal-fetal interface to prevent immune rejection of fetal cells. Nevertheless, systemic immunological changes occur in pregnant women. For example, condition of women suffering from autoimmune disorders improves during pregnancy. These changes in immune responses during pregnancy extend to maternal components specific to fetal antigens, because of feto-maternal cell transfer and their retention in mother tissues.During pregnancy, numbers of fetal cells in maternal tissues increase and correlate with expansion of CD4+ regulatory T cells. Decreased expansion and decidual accumulation of Treg cause pregnancy complications.
In mice models, most mother's fetal-specific CD8+ T cells undergo clonal deletion
and express low levels of chemokine receptors and ligands – this prevents remaining fetal-specific CD8+ T cells from entering the maternal-fetal interface. Mother's fetal-specific CD4+ T cells proliferate, and due to FOXP3 expression, differentiate into Treg cells. Mice models show that fetal-specific Treg cells are necessary for successful pregnancy.
Fetal tolerance to noninherited maternal antigens
Fetal T cells accumulate during in utero development. Even though the fetus is exposed to noninherited maternal antigens, fetal CD4+ T cells are capable of alloantigen-induced proliferation, preferentially differentiating to Treg cells and preventing a fetal immune response to maternal antigens. This expanded immune tolerance persists in both mother and offspring after birth and allows microchimeric cells to be retained in tissues.Postnatal tolerance to NIMAs
NIMA-specific tolerance causes some interesting immunological phenotypes: sensitization to erythrocyte Rhesus factor antigens is reduced among Rh- women born to Rh+ women, long-term kidney allograft survival is improved in NIMA-matched donor-recipient sibling pairs, or acuteness of bone marrow transplantation graft-versus-host disease is reduced, when recipients of donor stem cells are NIMA-matched.Cross-fostering animal studies show that when postnatal NIMA exposure though breastfeeding is eliminated, survival of NIMA-matched allografts is reduced. This suggests that to maintain NIMA-specific tolerance in offspring, breastfeeding is essential, but ingestion of mother's cells alone does not prime NIMA-specific tolerance. Both prenatal and postnatal exposure to mother's cells is required to maintain NIMA-specific tolerance.
Benefits of microchimeric cells
The severity of preexisting autoimmune disorders is reduced during pregnancy and it is most apparent when fetal microchimeric cells levels are highest - during the last trimester. These cells can also replace injured maternal cells and recover tissue function. Fetal microchimeric cells can differentiate into cell types that infiltrate and replace injured cells in models of Parkinson's disease or myocardial infarction. They also help in wound healing by neoangiogenesis. Seeding of fetal microchimeric cells into maternal tissues has been proposed to promote care of offspring after birth.Relationship with autoimmune diseases and breast cancer
Microchimerism has been implicated in autoimmune diseases. Independent studies repeatedly suggested that microchimeric cells of fetal origin may be involved in the pathogenesis of systemic sclerosis. Moreover, microchimeric cells of maternal origin may be involved in the pathogenesis of a group of autoimmune diseases found in children, i.e. juvenile idiopathic inflammatory myopathies. Microchimerism has now been further implicated in other autoimmune diseases, including systemic lupus erythematosus. Contrarily, an alternative hypothesis on the role of microchimeric cells in lesions is that they may be facilitating tissue repair of the damaged organ.Moreover, fetal immune cells have also been frequently found in breast cancer stroma as compared to samples taken from healthy women. It is not clear, however, whether fetal cell lines promote the development of tumors or, contrarily, protect women from developing breast carcinoma.
Systemic lupus erythematosus
The presence of fetal cells in mothers can be associated with benefits when it comes to certain autoimmune diseases. In particular, male fetal cells are related to helping mothers with systemic lupus erythematosus. When kidney biopsies were taken from patients with lupus nephritis, DNA was extracted and run with PCR. The male fetal DNA was quantified and the presence of specific Y chromosome sequences were found. Women with lupus nephritis containing male fetal cells in their kidney biopsies exhibited better renal system functioning. Levels of serum creatinine, which is related to kidney failure, were low in mothers with high levels of male fetal cells. In contrast, women without male fetal cells who had lupus nephritis showed a more serious form of glomerulonephritis and higher levels of serum creatinine.The specific role that fetal cells play in microchimerism related to certain autoimmune diseases is not fully understood. However, one hypothesis states that these cells supply antigens, causing inflammation and triggering the release of different foreign antigens. This would trigger autoimmune disease instead of serving as a therapeutic. A different hypothesis states that fetal microchimeric cells are involved in repairing tissues. When tissues get inflamed, fetal microchimeric cells go to the damaged site and aid in repair and regeneration of the tissue.